Up to one-third of patients experience limited benefit following surgical intervention for LS-OA. Thus, identifying contributing factors to this is important. People with OA often have multijoint involvement, yet this has received limited attention in this population. We documented the occurrence and evaluated the influence of multijoint symptoms on outcome following surgery for LS-OA.

141 patients undergoing decompression surgery+/−fusion for LS-OA completed the Oswestry Disability Index (ODI) pre- and 12-months post-surgery. Also captured pre-surgery: age, sex, education, BMI, smoking, depressive symptoms and comorbidities. Any joints with “pain/stiffness/swelling most days of the month” were indicated on a homunculus. A symptomatic joint site count (e.g. one/both knees= one site), excluding the back, was derived (range zero to nine) and considered as a predictor of magnitude of ODI change, and likelihood of achieving minimally clinically important improvement in ODI (MCID=12.8) using multivariable adjusted linear and log-Poisson regression analyses.

Mean age: 66 years (range:42–90), 46% female. 76% reported one+ joint site other than the back, 43% reported three+, and nearly 10% reported six+. (< MCID) for those with three sites, and four units for those with six+ sites. Associated with a greater likelihood of not achieving MCID were increasing joint count (11% increase per site (p=0.012)), higher BMI, current/former smoker, and worse baseline ODI tertile.

Results suggest there is more than just the back to consider to understand patient-reported back outcomes. Multijoint symptoms directly contribute to disability, but there is potential they may contribute to systemic, largely inflammatory, effects in OA as well.

The objective of this study was to quantify the burden of musculoskeletal disorders (MSDs) on the Ontario health care system. Specifically, we examined the magnitude and costs of MSD-associated ambulatory physician care and hospital service use, considering different physician types (e.g. primary care, rheumatologists, orthopaedic surgeons) and hospital settings (e.g. emergency department (ED), day surgery, inpatient hospitalizations).

Administrative health data were analyzed for fiscal year 2013/14 for adults aged 18+ years (N=10,841,302). Data sources included: Ontario Health Insurance Plan Claims History Database, which captures data on in- and out-patient physician services, Canadian Institute for Health Information (CIHI) Discharge Abstract Database, which records diagnoses and procedures associated with all inpatient hospitalizations, and CIHI National Ambulatory Care Reporting System, which captures data on all emergency department (ED) and day surgery encounters. Services associated with MSDs were identified using the single three digit International Classification of Diseases (ICD) version 9 diagnosis code provided on each physician service claim for outpatient physician visits and the “most responsible” ICD-10 diagnosis code recorded for hospitalizations, ED visits and day surgeries. Patient visit rates and numbers of patients and visits were tabulated according to care setting, patient age and sex, and physician specialty. Direct medical costs were estimated by care setting. Data were examined for all MSDs combined as well as specific diagnostic groupings, including a comprehensive list of both trauma and non-trauma related conditions.

Overall, 3.1 million adult Ontarians (28.5%) made 8 million outpatient physician visits associated with MSDs in 2013/14. These included 5.6 million primary care visits, nearly 15% of all adult primary care visits in the province. MSDs accounted for 560,000, 12.3%, of all adult ED visits. Patient visit rates to the ED for non-trauma spinal conditions were the highest of all MSDs at 1032 per 100,000 population, accounting for 23% of all MSD-related ED visits. Osteoarthritis had the highest rate of inpatient hospitalization of all MSDs at 340 per 100,000 population, accounting for 42% of all MSD-related admissions. Total costs for MSD-related care were $1.6 billion, with 12.6% of costs attributed to primary care, 9.2% to specialist care, 8.6% to ED care, and 61.2% of total costs associated with inpatient hospitalizations. Costs due to ‘arthritis and related conditions’ as a group accounted for 40.1% of total MSD costs ($966 million). Costs due to non-trauma related spinal conditions accounted for 10.5% ($168 million) of total MSD costs. All trauma-related conditions (spine and non-spine combined) were responsible for 39.4% ($627 million) of total MSD costs. MSD-related imaging costs for patients who made physician visits for MSDs were $169 million. Including these costs yields a total of $1.8 billion.

MSDs place a significant and costly burden on the health care system. As the population ages, it will be essential that health system planning takes into account the large and escalating demand for MSD care, both in terms of health human resources planning and the implementation of more clinically and cost effective models of care, to reduce both the individual and population burden.

The purpose of this study is to compare the efficacy of home based vs. inpatient rehabilitation following total joint arthroplasty (TJA). Primary outcome was the self-reported WOMAC pain and function score that was used to evaluate a stratified random sample of two hundred and thirty-two patients. Despite concerns about early hospital discharge there was no difference in functional outcomes at the primary endpoint (twelve weeks post TJA) between the group receiving home based vs. inpatient rehab. Given that home- based rehab is less expensive; we would recommend the use of home based rehab protocols following elective primary TJA.

Home- based rehab is increasingly utilized to save costs but concerns have been raised about early hospital discharge and adverse clinical outcomes. The aim of this RCT was to compare the efficacy of home based vs. inpatient rehab following Total Joint Arthroplasty (TJA).

Despite concerns about early hospital discharge there was no difference in functional outcomes twelve weeks post TJA between the group receiving home based vs. inpatient rehab.

With no significant difference in functional outcomes, less expensive home based rehabilitation protocols are recommended following elective total joint arthroplasty.

We randomized two hundred and thirty-two patients to either home based or inpatient rehab following TJA using block randomization techniques. All patients at a tertiary referral centre and large volume community hospital undergoing primary elective total hip or knee arthroplasty for osteoarthritis or inflammatory arthritis were eligible. Standardized care pathways were followed for both procedures. All patients were evaluated at baseline (two weeks prior to surgery) and twelve weeks post surgery using standardized questionnaires including history, physical exam, demographics and WOMAC pain and function (the primary endpoint). In total one hundred and fifteen received a total hip and one hundred and seventeen a total knee arthroplasty; there were eighty-five men and one hundred and forty-seven women with a mean age of sixty-seven (range thirty-eight to eighty-nine) years. The groups were similar at baseline for patient demographics and WOMAC scores. At follow-up (twelve weeks post TJA) there was no statistically significant difference in WOMAC scores.

Home- based rehab is increasingly utilized to save costs but concerns have been raised about early hospital discharge and adverse clinical outcomes. This study compares the efficacy and patient satisfaction of home- based verses inpatient rehabilitation following total joint arthroplasty (TJA). Despite concerns about early hospital discharge there was no difference in functional outcomes and in patient satisfaction with procedure at the primary endpoints, between the groups receiving home based verses inpatient rehabilitation.

This study compares the efficacy and patient satisfaction of home- based verses inpatient rehabilitation following total joint arthroplasty (TJA).

Given that home- based rehab is less expensive, we would recommend the use of home based rehab protocols following elective primary TJA.

Home- based rehab is increasingly utilized to save costs but concerns have been raised about early hospital discharge and adverse clinical outcomes.

The groups were similar at baseline for patient demographics and WOMAC scores. At the six weeks, twelve weeks and one- year follow-up post TJA there was no statistically significant difference in WOMAC pain, physical function, stiffness and overall WOMAC scores. Both groups showed a trend of decrease in pain, stiffness, restriction in physical function over the follow-up period. Similarly, patient satisfaction scores at six, twelve weeks and one year did not show a statistically significant difference between the home versus inpatient group (P> 0.05)

Two hundred and thirty-four patients were randomized to either home based or inpatient rehabilitation following TJA, using block randomization techniques. Standardized care pathways were followed for both procedures. All patients were evaluated at baseline (two weeks prior to surgery), six weeks, twelve weeks and one- year post surgery using standardized questionnaires. Primary outcomes were the self-reported WOMAC pain and function score and satisfaction in terms of improvement in pain and function.

Despite concerns about early hospital discharge there was no difference in functional outcomes and in patient satisfaction with procedure at the primary endpoints, between the groups receiving home based verses inpatient rehabilitation.

Funding: PSI

This study (n=126, mean age=68.8 years, males=62) evaluated pre-operative WOMAC pain and physical function, age, gender, general health status, revision severity classification, number of revisions, comorbidity and unilateral vs. bilateral surgery as predictors of WOMAC pain and physical function at twenty-four months post revision hip arthroplasty. Pain improved from 9.3 to 3.6 and physical function improved from 35.4 to 17.1. No factors were predictive of patient function. Decreased pain was predicted by less pain pre surgery (p=0.01) and being male (p=0.04).

To determine if pre-operative WOMAC pain and physical function, age, gender, general health status (SF-36), revision severity classification, number of revisions, comorbidity and unilateral vs. bilateral surgery are predictive of WOMAC pain and physical function at twenty-four months post revision hip arthroplasty.

Physical function at twenty-four months is not independently predicted by the pre-treatment factors evaluated in this study. Male patients with less pain pre surgery and little comorbidity have less pain post surgery.

With the exception of pre-treatment pain, the pre-treatment factors tested in this study provide minimal guidance in identifying factors that might be modified to enhance patient outcome.

This prospective cohort study included one hundred and twenty-six patients (mean age=68.8 years, males: females=62:64) who had revision for other than infection or peri-prosthetic fracture. On average from pre-surgery to twenty-four months post-surgery, WOMAC pain improved 9.3 to 3.6 and physical function improved from 35.4 to 17.1. In univariate analysis (t-test, p< 0.05), males tended to have better function (19.6 vs. 14.7) and reported less pain (4.4 vs. 2.8). No other factors were significant in univariate analysis. None of the a priori factors noted above were independently predictive of patient function at twenty-four months in the multivariate model (F=2.06, p=0.04, R²=0.16). Decreased pain with activity at twenty-four months independently was predicted by having less pain pre surgery (p=0.01), being male (p=0.04) and having fewer comorbidities (p=0.07) in the multi-variate model (F=2.9. p=0.004, R²=0.21).

Funding: This work was supported by a grant from The Arthritis Society